Provider Demographics
NPI:1124158357
Name:SHERIDAN, KATHERINE REEVES (NP)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:REEVES
Last Name:SHERIDAN
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:SHERIDAN
Other - Last Name:CROCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN
Mailing Address - Street 1:9 PEACH BLOSSOM SQ
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2514
Mailing Address - Country:US
Mailing Address - Phone:615-517-5477
Mailing Address - Fax:
Practice Address - Street 1:620 GALLATIN PIKE S
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4013
Practice Address - Country:US
Practice Address - Phone:615-460-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7324363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3908923Medicare ID - Type Unspecified
TNP38259Medicare UPIN